Swallowing assessment and improvement systems and methods

ABSTRACT

The present disclosure relates to devices, systems, and methods for assessing and altering swallowing, speech, and breathing function. In particular, the present disclosure relates to devices and systems to assess and improve speech, breathing, and swallowing function in subjects in need thereof.

The present application is a continuation of U.S. patent applicationSer. No. 14/457,945, filed Aug. 12, 2014, which claims priority to U.S.Provisional Patent Application Ser. Nos. 61/864,994, filed Aug. 12,2013, 61/877,712, filed Sep. 13, 2013, and 61/889,930, filed Oct. 11,2013, the entire disclosures of which are herein incorporated byreference in their entireties.

FIELD OF THE INVENTION

The present disclosure relates to devices, systems, and methods forassessing and altering swallowing, speech, and breathing function. Inparticular, the present disclosure relates to devices and systems toassess and improve speech, breathing, and swallowing function insubjects in need thereof.

BACKGROUND OF THE INVENTION

Dysphagia, or swallowing disorder, is a general term used to describethe inability to move food from the mouth to the stomach. Some patientshave limited awareness of their dysphagia, so lack of the symptom doesnot exclude an underlying disease or condition. When dysphagia goesundiagnosed or untreated, patients are at a high risk of pulmonaryaspiration and subsequent aspiration pneumonia secondary to food orliquids going the wrong way into the lungs. Some people present with“silent aspiration” and do not cough or show outward signs ofaspiration. Undiagnosed dysphagia also can result in dehydration,malnutrition, renal failure, and repeated episodes of aspirationpneumonia.

Swallowing disorders can occur in all age groups, resulting fromcongenital abnormalities, structural damage, and/or medical conditions.Swallowing problems are a common complaint among older individuals, andthe incidence of dysphagia is higher in the elderly, in patients whohave had strokes, and in patients who are admitted to acute carehospitals or chronic care facilities. Dysphagia is a symptom of manydifferent causes, which can usually be identified through a carefulhistory by the treating physician. A formal oropharyngeal dysphagiaevaluation is performed by a speech language pathologist.

The goals of treatment are to maintain adequate nutritional andhydrational intake and to maximize airway protection. Rehabilitationtherapy is the main stay of dysphagia management and allows for safeswallowing. Rehabilitation requires the cooperation of the patient andthe ability of the patient to understand and follow commands. Typicaltherapy programs involve oral feeding with consistency modifications,compensatory strategies to reduce the risk of aspiration, strengtheningtherapy to increase muscle tone and augment oropharyngeal swallow, andmedical therapies.

One condition related to dysphagia is obstructive sleep apnea. (SeeValbuza et al., Swallowing dysfunction related to obstructive sleepapnea: a nasal fibroscopy pilot study, Sleep Breath 15(2):209-13(2011)). Obstructive sleep apnea (OSA) is the most common category ofsleep-disordered breathing. The muscle tone of the body ordinarilyrelaxes during sleep, and at the level of the throat the human airway iscomposed of collapsible walls of soft tissue which can obstructbreathing during sleep. Mild occasional sleep apnea, such as many peopleexperience during an upper respiratory infection, may not be important,but chronic severe obstructive sleep apnea requires treatment to preventlow blood oxygen (hypoxemia), sleep deprivation, and othercomplications. Individuals with low muscle tone and soft tissue aroundthe airway (e.g., because of obesity) and structural features that giverise to a narrowed airway are at high risk for obstructive sleep apnea.The elderly are more likely to have OSA than young people. Men are morelikely to suffer sleep apnea than women and children.

Additional therapies are needed to assess and improve swallowingfunction, speech, and breathing functions.

SUMMARY OF THE INVENTION

The present disclosure relates to devices, systems, and methods forscreening for and improving oropharyngeal strength generated forswallowing, speech, and breathing functions. In particular, the presentdisclosure relates to devices and systems to assess and improveswallowing, breathing, and speech functions in subjects in need thereof.

In some embodiments, provided herein are systems and methods comprisingone or more or all of: an intraoral component comprising sensors thatassess and/or improve swallowing capability; a communication componentthat transmits information from the sensors to an information processingcomponent; an information processing component that collects, stores,and/or manages data received from the sensors; and a protocol componentthat manages and guides use of the system by clinician, the treatedsubject, and/or their caregiver.

In some embodiments, the intraoral component comprises: a flexible metalframe, one or a plurality of pressure sensors at one or more sensorlocations on the frame, and/or a registration component proximal to theplurality of pressure sensors. In some embodiments, the frame isstainless steel. In some embodiments, the registration componentcomprises two sliding components configured to fit around the teeth(e.g., natural or artificial teeth), gum, or prosthesis of a subject. Insome embodiments, the one or plurality of pressure sensors comprisesone, two, three, four, five, or more sensors. In some embodiments, theframe is approximately 2 mm thick (e.g., 0.5 to 5 mm, 1 to 3 mm, etc.).In some embodiments, the frame is approximately 3 to 10 cm in length(e.g., 3, 4, 5, 6, 7, 8, 9, 10 cm or fractions thereof). In someembodiments, the frame is 0.1 to 1 cm in width (e.g., 0.2, 0.5, 0.75,etc.). In some embodiments, the frame has a composition and shape (e.g.thickness) that provides tensile strength, malleability, and ductabilitysufficient to withstand stress associated with repeated bending by ahuman hand up to 90 degrees (e.g., 10, 20, 30, 40, 50, 60, 70, 80, 90degrees or fractions thereof).

In some embodiments, provided herein are methods of assessing swallowingfunction, comprising: a) contacting the aforementioned intraoralcomponent with the mouth of a subject; and b) assessing swallowingfunction using the intraoral component. In some embodiments, the methodfurther comprises the step of providing the subject a swallowing therapyprogram based on the swallowing function. In some embodiments, thecontacting comprises bending the device to conform the device to thecontours of the subject's hard palate. In some embodiments, thecontacting comprises positioning the distal tip of a sensor at theboundary between the soft and hard palate. In some embodiments, thecontacting comprises sliding one or more of the registration componentsaround teeth or gums to secure the device in place.

In some embodiments, the intraoral component comprises a plurality ofpressure sensors. In embodiments, the pressure sensors are located on atop surface of the frame that, when formed to a subject's mouth reside,make contact with the tissue of the hard palate (see e.g., FIG. 3 forupper mouth anatomy). In some embodiments, the pressure sensors arewireless, solid-state sensors. In some embodiments, the pressure sensorsare actuated by pressure applied by the tongue to the lower surface ofthe frame.

In some embodiments, a communication component wirelessly communicatesdata collected by the sensors to the information processing component.

In some embodiments, the information processing component is a portablecomputing device, such as a tablet computer, comprising a processor. Insome embodiments, the information processing component comprises atouchscreen display with a graphical user interface.

In some embodiments, the protocol component is contained on a computerreadable medium that is implemented by the processor of the informationprocessing component. In some embodiments, the protocol componentcomprises one or more or all of: a) a diagnostic protocol that displays,for example, a graphical diagnostic program to a subject, for assessingswallowing capability with the intraoral component and for recording andanalyzing data collected from sensors from the implementation of theprogram; b) a therapeutic protocol that displays, for example, agraphical therapeutic program to a subject, for improving, maintaining,or preventing reduction in swallowing capability with the intraoralcomponent and for recording and analyzing data collected from sensorsfrom the implementation of the therapeutic program; and c) an alarmprotocol that alerts subjects and/or their caregivers to actions orinactions that threaten optimized performance of the diagnostic ortherapeutic protocols or to health changes that require medicalintervention.

Further provided herein are methods for the system for assessing orimproving swallowing capability.

In some embodiments, provided herein are methods and systems for chronicdisease management comprising: a health monitoring device, a secureserver, and a clinician device. In some embodiments, the healthmonitoring device is configured to send time-stamped metrics andcollect, receive, manage, and/or store messages from the secure server;the secure server is configured to collect, receive, manage, and/orstore time-stamped metrics from the health monitoring device andmessages from the clinician device; the secure server is configured tosend messages to the health monitoring device and alerts and/or reportsto the clinician device; and the clinician device is configured to sendmessages to and collect, receive, manage, and/or store alerts and/orreports from the secure server.

In some embodiments, the health monitoring device collects, manages,and/or stores metrics regarding a subject's health and relays thosemetrics directly to the clinician device or indirectly to the cliniciandevice via a secure server. In some embodiments, the metrics aretransformed or modified by the secure server into alerts and/or reports.In some embodiments, a clinician analyzes the metrics, alerts, and/orreports and determines a treatment plan. In some embodiments, theclinician uses the clinician device to relay a treatment plan directlyor indirectly via the secure server to the health monitoring device. Insome embodiments, the health monitoring device implements the treatmentplan by displaying messages to the subject, prompting the subject toperform various exercises, or modifying an existing treatment plan.

In some embodiments, provided herein are systems and methods formanaging a subject's speech, breathing, and/or swallowing function,comprising software running on a computer that provides one or more orall of: a) one or more therapeutic protocols communicated over anelectronic communication network and displayable on a patient computer;b) a clinician interface communicated over an electronic communicationnetwork and displayable on a clinician computer; and c) anadministrative interface displayable on an administration computer. Insome embodiments, the clinician interface and/or the administrativeinterface allows for the association of two or more health carefacilities with a patient account or clinician account.

Additional embodiments are described herein.

DESCRIPTION OF THE FIGURES

FIG. 1 shows an exemplary swallowing assessment device of embodiments ofthe present disclosure.

FIG. 2 shows a drawing of a metal spline of an exemplary swallowingassessment device of embodiments of the present disclosure.

FIG. 3 shows a diagram of a human hard and soft palate.

FIG. 4 shows an embodiment of a system comprising an intraoral component8 comprising a plurality of pressure sensors 50, a communicationcomponent 60 (e.g., wireless transmitter), an information processingcomponent 70 comprising a display 75, and a protocol component 80 (e.g.,embodied in a computer memory within the information processingcomponent).

FIG. 5 shows an embodiment of a control system for managing devices andinformation between patients and clinicians.

FIG. 6 shows an embodiment of a control system for managing devices andinformation between clinicians and service administrators.

DEFINITIONS

To facilitate understanding of the invention, a number of terms aredefined below.

As used herein, the terms “processor” and “central processing unit” or“CPU” are used interchangeably and refer to a device that is able toread a program from a computer memory (e.g., ROM or other computermemory) and perform a set of steps according to the program.

As used herein, the terms “computer memory” and “computer memory device”refer to any storage media readable by a computer processor. Examples ofcomputer memory include, but are not limited to, RAM, ROM, computerchips, digital video discs (DVD), compact discs (CDs), hard disk drives(HDD), and magnetic tape.

As used herein, the term “computer readable medium” refers to any deviceor system for storing and providing information (e.g., data andinstructions) to a computer processor. Examples of computer readablemedia include, but are not limited to, DVDs, CDs, hard disk drives,magnetic tape and servers for streaming media over networks.

As used herein, the term “in electronic communication” refers toelectrical devices (e.g., computers, processors, etc.) that areconfigured to communicate with one another through direct or indirectsignaling.

DETAILED DESCRIPTION

The present disclosure relates to devices, systems, and methods forassessing and altering pressure necessary for adequate swallowing,speech, and breathing function. In particular, the present disclosurerelates to devices and systems to assess and improve swallowing,breathing, and speech functions in subject in need thereof.

Approximately 40 mouth and throat pairs of muscles and many nerves arerequired for the complex, coordinated act of swallowing. The tonguepropels food into the throat, which sends it on to the esophagus andstomach. During the transition from the mouth to the esophagus, the foodor liquid moves past the larynx and trachea (windpipe), which leaddirectly to the lungs.

During swallowing, a trough is formed on the tongue by the intrinsicmuscles. The trough obliterates against the hard palate from front toback, forcing the bolus to the back of the tongue. The intrinsic musclesof the tongue contract to make a trough (a longitudinal concave fold) atthe back of the tongue. The tongue is then elevated to the roof of themouth (by the mylohyoid (mylohyoid nerve), genioglossus, styloglossusand hyoglossus) such that the tongue slopes downwards posteriorly. Thecontraction of the genioglossus and styloglossus also contribute to theformation of the central trough.

At the end of the oral preparatory phase, the food or liquid bolus hasbeen formed and is ready to be propelled posteriorly into the pharynx.In order for anterior to posterior transit of the bolus to occur,orbicularis oris contracts and adducts the lips to form a tight seal ofthe oral cavity. Next, the superior longitudinal muscle elevates theapex of the tongue to make contact with the hard palate and the bolus ispropelled to the posterior portion of the oral cavity. Once the bolusreaches the palatoglossal arch of the oropharynx, the pharyngeal phase,which a patterned response, then begins. Receptors initiating thisresponse are proprioceptive. They are scattered over the base of thetongue, the palatoglossal and palatopharyngeal arches, the tonsillarfossa, uvula and posterior pharyngeal wall. Stimuli from the receptorsof this phase then provoke the pharyngeal phase.

For the pharyngeal phase to work properly all other egress from thepharynx must be occluded—this includes the nasopharynx and the larynx.When the pharyngeal phase begins, other activities such as chewing,breathing, coughing and vomiting are concomitantly inhibited.

The soft palate is tensed by tensor palatini (Vc), and then elevated bylevator palatini (pharyngeal plexu) to close the nasopharynx. There isalso the simultaneous approximation of the walls of the pharynx to theposterior free border of the soft palate, which is carried out by thepalatopharyngeus (pharyngeal plexus) and the upper part of the superiorconstrictor (pharyngeal plexus).

The pharynx is pulled upward and forward by the suprahyoid andlongitudinal pharyngeal muscles—stylopharyngeus, salpingopharyngeus(pharyngeal plexus) and palatopharyngeus (pharyngeal plexus) to receivethe bolus. The palatopharyngeal folds on each side of the pharynx arebrought close together through the superior constrictor muscles, so thatonly a small bolus can pass.

The actions of the levator palatini (pharyngeal plexus) tensor palatiniand salpingopharyngeus (pharyngeal plexus) in the closure of thenasopharynx and elevation of the pharynx opens the auditory tube, whichequalizes the pressure between the nasopharynx and the middle ear. Thisdoes not contribute to swallowing, but happens as a consequence of it.

The oropharynx is kept closed by palatoglossus (pharyngeal plexus), theintrinsic muscles of tongue and styloglossus.

It is true vocal fold closure that is the primary laryngopharyngealprotective mechanism to prevent aspiration during swallowing. Theadduction of the vocal cords is effected by the contraction of thelateral cricoarytenoids and the oblique and transverse arytenoids (allrecurrent laryngeal nerve of vagus). Since the true vocal folds adductduring the swallow, a finite period of apnea (swallowing apnea) mustnecessarily take place with each swallow. When relating swallowing torespiration, it has been demonstrated that swallowing occurs most oftenduring expiration, even at full expiration a fine air jet is expiredprobably to clear the upper larynx from food remnants or liquid. Theclinical significance of this finding is that patients with a baselineof compromised lung function will, over a period of time, developrespiratory distress as a meal or oral hydrational intake progresses.Subsequently, false vocal fold adduction, adduction of the aryepiglotticfolds and retroversion of the epiglottis take place. The aryepiglotticus(recurrent laryngeal nerve of vagus) contracts, causing the arytenoidsto appose each other (closes the laryngeal aditus by bringing thearyepiglottic folds together), and draws the epiglottis down to bringits lower half into contact with arytenoids, thus closing the aditus.Retroversion of the epiglottis, while not the primary mechanism ofprotecting the airway from laryngeal penetration and aspiration, acts toanatomically direct the food bolus laterally towards the pyriform fossa.Additionally, the larynx is pulled up with the pharynx under the tongueby stylopharyngeus, salpingopharyngeus (pharyngeal plexus),palatopharyngeus (pharyngeal plexus) and inferior constrictor(pharyngeal plexus). This phase is passively controlled relativelyautomatically and involves cranial nerves.

The hyoid is elevated by digastric and stylohyoid, lifting the pharynxand larynx up even further. The bolus moves down towards the esophagusby pharyngeal peristalsis which takes place by sequential contraction ofthe superior, middle and inferior pharyngeal constrictor muscles(pharyngeal plexus). This muscular sequence also cleans up residue inthe pharynx after the swallow. The lower part of the inferiorconstrictor (cricopharyngeus) is normally closed and only opens for theadvancing bolus.

The esophageal phase of swallowing is under involuntary neuromuscularcontrol. Propagation of the food bolus is significantly slower than inthe pharynx. Finally the larynx and pharynx move down with the hyoidmostly by elastic recoil.

Obstructive sleep apnea (OSA) is the most common category ofsleep-disordered breathing. The muscle tone of the body ordinarilyrelaxes during sleep, and at the level of the throat the human airway iscomposed of collapsible walls of soft tissue which can obstructbreathing during sleep. Mild occasional sleep apnea, such as many peopleexperience during an upper respiratory infection, may not be important,but chronic severe obstructive sleep apnea requires treatment to preventlow blood oxygen (hypoxemia), sleep deprivation, and othercomplications. Individuals with low muscle tone and soft tissue aroundthe airway (e.g., because of obesity) and structural features that giverise to a narrowed airway are at high risk for obstructive sleep apnea.The elderly are more likely to have OSA than young people. Men are morelikely to suffer sleep apnea than women and children.

Loss of swallowing, speech, or breathing capability, which may be causedby any number of factors, creates multiple health risks, as described inthe background section above. The systems and methods herein allowsubject and their caregivers to assess swallowing, speech, or breathingcapability and to improve swallowing, speech, or breathing capability,if needed.

In some embodiments, the system comprises one or more or all of: anintraoral component, a communication component, an informationprocessing component, and a protocol component. Illustrative embodimentsof each of these components, and their integration into the system, isdescribed below. In some embodiments, systems and methods of chronicdisease management are provided comprising a patient device, a secureserver, and a clinician device as described below.

I) Intraoral Component

In some embodiments, the systems and methods comprise an intraoralcomponent. The intraoral component can provide a variety of functions,including but not limited to: the ability to assess swallowingcapability or a sub-component of swallowing (e.g., muscle strength ofparticular muscles or regions of muscles), qualitatively and/orquantitatively; the ability to monitor swallowing at particular timeintervals or in real-time; and the ability to improve, maintain, orreduce the reduction in swallowing capability using a therapeuticprotocol.

Exemplary subcomponents of the intraoral component include, but are notlimited to: a frame configured for placement of the intraoral componentin the mouth of a subject; one or more sensor locations positioned onthe frame; one or more sensors positioned at the sensor locations; acomputer chip with a serial number; and a registration component thatpositions the intraoral component relative to a physical architecture ofthe subject (e.g., teeth, gum, artificial prosthesis, etc.).

In some embodiments, the frame is shaped for desired placement in amouth of the subject (e.g., a human subject). In some embodiments, theplacement is on the roof of the mouth, whereby the intraoral devicemakes physical contact with the roof of the mouth. In some embodiments,the intraoral device makes physical contact with the roof of the mouthover a substantial portion of the surface area of the frame (e.g., over50% of one surface of the frame makes contact with the roof of themouth, over 60%, 70%, 80%, 90, 95%, . . . , 100%). The intraoralcomponent is not limited by the shape of the frame. Any number of frameshapes may be employed. In some embodiments, the frame comprises acentral linear portion having a distal end that is positioned towardsthe back of the mouth and a proximal end that is positioned towards theanterior opening of the mouth. In some embodiments, the central linearportion is rectangular in its length/width dimensions and is relativelythin (e.g., less than 5 mm, less than 3 mm, less than 2 mm, less than 1mm) in its depth dimension. In some embodiments, one or more branches(e.g., linear branches) extend outward from the central linear portion.For example, in the embodiment shown in FIG. 2, a linear central portion10 of the frame 5 of the intraoral component comprises first 20 andsecond 21 linear branches extending outward at a 90% angle. The framemay have fewer (e.g., zero, one) or greater (e.g., 3, 4, 5, 6, etc.)numbers of branches in any desired orientation, shape, or position.

In some embodiments, the frame is formed to fit within the roof of themouth. In some such embodiments, the frame may be configured for anaverage subject (e.g., “one size fits all”) or may be provided inseveral different one size fits all categories (e.g., small, medium,large, child, etc.). In other embodiments, a frame may be designed(e.g., based on a cast mold) for a patient-specific fit. In yet otherembodiments, the frame may be bendable or otherwise configurable toadjust to fit the mouth a specific subject. An exemplary fittedintraoral component 8 is shown in FIG. 1. The device has a curvedcentral linear portion 10. Two curved linear branches, 20 and 21, areprovided.

Outside of physical constraints of the mouth, comfort considerations,and utility considerations, the intraoral device is not limited in thedimensions of the frame. However, in some embodiments, particularlythose where the frame is adjustable, dimensions are selected to permiteasy adjustment by a caregiver or by a subject while also providingsufficient durability to withstand adjustment (e.g., multipleadjustments). Such dimensions may be weighed also in view of thematerials selected (described in more detail below). Referring back tothe embodiments shown in FIG. 2, in some embodiments, the central linearportion is approximately 2 mm thick (e.g., 0.5 to 5 mm, 1 to 3 mm,etc.). In some embodiments, central linear portion is approximately 3 to10 cm in length (e.g., 3, 4, 5, 6, 7, 8, 9, 10 cm or fractions thereof).In some embodiments, the central linear portion is 0.1 to 1 cm in width(e.g., 0.2, 0.5, 0.75, etc.). The linear branches may be similarlydimensioned or may be longer, shorter, thinner, or wider, as desired.Typically, the linear branches are shorter and narrower than the centrallinear portion. The width and thickness need not be constant through thelength of the central linear portion or the linear branches.

The frame may be made of any suitable material, including but notlimited to, metals, ceramics, and plastics, or combinations thereof.Preferably the frame is made of a biocompatible material or is coatedwith or encompassed within a biocompatible material. In someembodiments, the frame uses a material and shape (e.g. thickness) thatprovides tensile strength, malleability, and ductability sufficient towithstand stress associated with repeated (e.g., 2×, 3×, 5×, 10×, 100×,1000×, 10,000×, etc.) bending by a human hand up to 90 degrees (e.g.,10, 20, 30, 40, 50, 60, 70, 80, 90 degrees or fractions thereof). Insome embodiments, the frame is made of stainless steel (e.g., stainlesssteel type 316). Embodiments constructed of stainless steels anddimensioned as shown in FIG. 2 have demonstrated durability andadjustability for optimized fit with a human subject's mouth.

In some embodiments, the frame comprises attachment features (e.g.,holes, pins, latches, tabs, snaps, ridges, etc.) that permit othercomponents to be attached to the frame (e.g., sensors, coatings,coverings, communication components, etc.). In some embodiments, theframe comprises markings or other fiducials for monitoring, visually orelectronically, the position of the frame while the device is beingmanufactured, placed into an oral cavity of a subject, or used.

In some embodiments, the intraoral component comprises one or moresensor locations: i.e., locations on the frame or attached to the frameand configured for the placement of a sensor. In some embodiments, thesensor locations comprise regions of the frame that are shaped for themounting of a sensor. For example, as shown in FIG. 2, four circularregions 30 are provided on the frame as sensor locations: a first sensorlocation 31 centrally located along the central portion 10 of the frame,a second sensor location 32 located at the distal end of the centralportion 10 of the frame, a third sensor location 33 located at thedistal end of branch 20, and a fourth sensor location 34 located at thedistal end of branch 21. The intraoral device may have any number ofdesired sensor locations (e.g., 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, etc.).Further, the sensor locations may be positioned at any desired locationon the frame. In some embodiments, the sensors are of appropriate numberand location to facilitate the use of the device (e.g., qualitative orquantitative assessment of swallowing; maintenance or improvement ofswallowing; etc.). For example, in some embodiments, the sensor location32, located at the distal-most point of the frame is positioned toreside at the back boundary of the hard palate of a subject. The sensorlocations may have any desired size and shape. In some embodiments, thesize and shape of the sensor location is selected to provide anappropriate base of attachment for a sensor: stability, reliability,physical placement relative to the architecture of the subject's oralcavity, shape/size of the sensor, accommodating any communicationcomponents (e.g., wires) associated with a sensor, etc. In someembodiments, the sensor locations comprise attachment features (e.g.,holes, pins, latches, tabs, snaps, ridges, etc.) for associating asensor with the sensor location. In some embodiments, the sensorlocations comprise markings or other fiducials for monitoring, visuallyor electronically, the position of the sensor locations while the deviceis being manufactured, placed into an oral cavity of a subject, or used.

In some embodiments, the intraoral component comprises one or moresensors (e.g., positioned at one or more of the sensor locations). Insome embodiments, the sensors are positioned on the lower surface of theframe when the upper surface of the frame is in contact with the hardpalate of the oral cavity of a subject. In other embodiments, thesensors are positioned on the upper surface, such that they residebetween the frame and the tissue of the hard palate of the oral cavityof a subject. In some embodiments, the sensors are on both the upper andlower side of the frame at one or more sensor locations. In some suchembodiments, a single sensor may extend around the edge of the frame andoccupy both sides of the frame at the sensor location. In otherembodiments, a first sensor is located on one side of a sensor locationand a second sensor is located on the other side of the sensor location.

Sensors may be employed that sense any desired property. In someembodiments, the sensors detect force or pressure changes. For example,in some embodiments, the sensors detect force or pressure applied by thetongue directly to a sensor or applied by the tongue to the frame,applying force or pressure on a sensor located between the frame andtissue. In some embodiments, sensors are used that detect one or moreof: motion, magnetic field, gravity, humidity, moisture, vibration,electrical field, position (e.g., of the tongue), temperature, chemicalsor molecules (e.g., ethanol, toxins, nutrients, pheromones, oxygen,carbon dioxide, glucose, hormones, cytokines), organisms (e.g.,pathogens), light, sound, and pH. Such sensors include, but are notlimited to, geophones, hydrophones, lace sensors, microphones,seismometers, chemical sensors, electrochemical gas sensors,ion-selective electrodes, infrared point sensors, nondispersive infraredsensors, redox electrodes, olfactometers, current sesnors,galvanometers, magnetometers, MEMS magnetic field sensors, voltagedetectors, air flow meters, flow sensors, accelerometers, gyroscopes,capacitive displacement sensors, gravimeters, inclinometers, laserrangefinders, laser surface velocimeters, tilt sensor, photodetectors,barographs, barometers, bourdon gauges, piezometers, pressure sensors(e.g., absolute pressure sensors, gauge pressure sensors, differentialpressure sensors, sealed pressure sensors), tactile sensors, timepressure gauges, force gauge, viscometer, thermometer, motion detector,occupancy sensor, proximity sensor, and triangulation sensor. Pressuresensors include, but are not limited to, force collector types (e.g.,piezoresistive strain gauges (e.g., silicon (monocrystalline),polysilicon thin film, bonded metal foil, thick film, and sputtered thinfilm); capacitive (e.g., metal, ceramic, and silicon diaphragms);electromagnetic (e.g., measurement of displacement of a diaphragm bymeans changes in inductance, LVDT, Hall Effect, or by eddy currentprinciple); piezoelectric, optical (e.g., using fiber bragg gratings);and potentiometic) and other types (e.g., resonant; thermal; andionization).

In some embodiments, sensors operate in continuous mode, for examplecollecting data in real-time or at desired time points. In otherembodiments, sensors operate on command at designated time points ortime intervals. Sensors may receive information (e.g., operatinginstructions) or transmit information (e.g., collected data) via anydesired communication mechanism, including wired and wirelessapproaches.

In some embodiments, for pressure sensors to detect pressure applied bythe tongue, the size and shape of the sensors is selected to accommodatelocation of the sensor itself or the sensor location on the frame by thetongue of a subject and to permit pressing of the tongue on theintraoral device to actuate the sensor.

In some embodiments that employ a pressure sensor, the pressure sensordetects the amount of pressure applied to the sensor. Pressure amountsmay be measured in any desirable units (e.g., pounds per square inch(psi), pounds per square foot (psf), kilograms-force per squarecentimeter (kgf/cm²), kilopound per square inch (ksi), Pascals (Pa),Torrs, bars (bar), baryes (Ba), atmospheres (at), arbitrary units, etc.)and may be strictly quantitative or semi-quantitative (e.g., pressureranges assigned as a single value; e.g., high, medium, low, etc.). Insome embodiments, the pressure sensor detects the timing of pressureapplied to sensor. In some embodiments, the pressure sensor detects achange in pressure over time applied to the sensor. In some embodiments,the pressure sensor detects one or more threshold pressure events (e.g.,the existence of a defined pressure amount at a point in time).

In some embodiments each sensor present on the intraoral device, ifmultiple are present, act independently of one another. In otherembodiments, two or more sensors work in a coordinated fashion. Forexample, in some embodiments, pressure is applied to two or more sensorsimultaneously and, alternatively, a pressure value at each sensor ismeasured or a summed pressure at plurality of sensors is measured. Insome embodiments, two or more sensors are located in immediate proximityto one another and each member of the set measure pressure at adifferent time point during a pressure event.

Wires, if used, may be directed from the sensor(s) along the length ofthe frame, for example, terminating at the proximal end of the frame.

In some embodiments, INTERLINK ELECTRONICS FSR sensors (FORCE SENSINGRESISTOR) are employed. FSRs are robust polymer thick film (PTF) devicesthat exhibit a decrease in resistance with increase in force applied tothe surface of the sensor. Such sensors actuate force as low as 0.2N,are low cost, ultra-thin, robust (up to 10 million actuations), andsimple and easy to integrate into the intraoral component. Other similarsensors may also be employed. In some embodiments, such ultra-thinsensors comprise a bottom substrate, a gusset layered on the bottomsubstrate outside of the active area, the sensor electronics adjacent tothe gusset and forming the active area, and, optionally, a spaceradhesive adjacent to the sensor electronics opposite the gusset. A topsubstrate is layered over the sensor electronics and the spacer adhesiveand an adhesive layer is layered on top of the top substrate.

In some embodiments, the gusset provides a distinct region which thesubject can feel with his or her tongue in order to accurately directlingual pressure to the pressure sensor. In some embodiments, the gussetis made of foam (e.g., silicone foam).

In some embodiments, sensors are prepared or placed by printingtechnologies. For example, in some embodiments, one or more sensors isprinted on a solid support under computer control to provide exactlocation and size and consistent design from device to device.

In some embodiments, the intraoral component comprises a power sourcethat powers any electrical components. In some embodiments, the powersource is one or more batteries.

In some embodiments, the intraoral component comprises a registrationcomponent. The registration component functions to fix the location ofthe intraoral component in an oral cavity of a subject relative tophysical architecture—typically a portion of the subject's body. In someembodiments, the physical architecture is the subject's teeth (e.g.,natural or artificial) or gums. In some embodiments, the architecture isa prosthesis or appliance (e.g., denture, Ajers' clasp, veneer,removable partial denture (RPD), braces, retainer, palatal expander,bite plate, headgear, facemask, forsus/herbst, pendex/pendulum, lipbumper, space maintainer, spacer/separator, etc.).

In some embodiments, the intraoral component comprises a computer chipwith a serial number. The computer chip functions to uniquely identifythe intraoral device. In some embodiments, information generated by theintraoral device (e.g., time-stamped metrics) includes the unique serialnumber of the intraoral device. Identification of the particular deviceresponsible for generating a given piece of information allows aclinician to maintain accurate records and make appropriate treatmentdecisions.

FIG. 1 shows an exemplary embodiment of a registration componentconfigured for positioning an intraoral component relative to the teethor gums of a subject (or denture, etc.). In some embodiments, theregistration component comprises one or more sub-components. In someembodiments, one of the plurality of components is movable (e.g., ableto slide along a portion of the intraoral component frame) and the otherregistration components are immobile (e.g., affixed to the intraoralcomponent frame). In some embodiments, the device comprises tworegistration components that both are movable (e.g., able to slide alonea portion of the intraoral component frame). In some embodiments, amoveable component is moved to the appropriate position and locked intoplace. In some embodiments, locking is achieved by a locking mechanism,including but not limit to, a latch, a hook and eye, peg and hole,suction, physical attachment to the architecture, or any other desiredmechanism. In some embodiments, the moveable sub-component of theregistration component is restrained by friction, such that a firstforce is needed to move the sub-component (e.g., a force applied from asubject hand or a treating physician's hand), but a second force (e.g.,forces generated during the normal use of the intraoral component) isinsufficient to move the sub-component. Such friction can be generatedby choice of materials (e.g., rubber, plastic, or other materials havinga sufficient coefficient of friction relative to the surface on whichthey move) and/or sizing of the sub-components (e.g., providing a snugfit around the frame of the intraoral component).

In some embodiments, the placement of the intraoral component locationis adjusted using the registration component. In other embodiments, theintraoral component is first positioned into the oral cavity and thenthe registration component is used to lock the intraoral component intothat position.

In the example shown in FIG. 1, two sub-components 41 and 42 of aregistration component 40 are shown. Each of the sub-componentscomprises an interior opening 43 through which the central portion ofthe frame 10 of the intraoral device is inserted. As shown in FIG. 1,the interior opening 43 is sized to provide a tight fit around theframe. Each sub-component has a base 44 and an upper region 45 having asmaller surface area than the base on which is sits. As such, when thetwo sub-components 41 and 42 are positioned in proximity to one anotheralong the central portion of the frame 10, a gap is created between therespective upper regions of the two sub-components. In some embodiments,the teeth of a subject are positioned within the space between the basesof the two sub-components in physical contact with the interior surfaceof one or both bases and the gums fit between the gap created betweenthe respective upper regions.

One or more of the sub-components of the intraoral component may becoated or covered, for example, with rubber, plastic, or other desiredmaterials (e.g., silicone such as MASTERSIL 151MED, Qmed). Coatings maybe used for any number of reasons, including but not limited to,providing a biocompatible contact surface, sealing electronic componentsfrom fluid, moisture, or other materials of the oral cavity of asubject, holding in place sensors, wires, or other sub-components to theframe, providing a frictional surface for a movable registrationcomponent, providing pleasant mouth feel and taste, increasingdurability, and providing an easy to handle surface texture forplacement in the oral cavity and use.

In some embodiments, the intraoral component is configured as adisposable, single-use or limited use device. As such, after one use orafter multiple separate uses by a subject for a set period of time(e.g., 1 day, 1 week, 1 month with, for example, daily use) theintraoral component is disposed of and if continued use is needed, a newintraoral component is provided. In some embodiments, for disposableuse, the intraoral component is packaged separately from othercomponents of the system. Packing may include two or more intraoralcomponents. Preferably, each intraoral component is independentlypackaged (e.g., in a sealed sterile container, such as a plastic bag),even if two or more such intraoral components are sold or providedtogether (e.g., in a box). In some embodiments, the packaging provideswritten or diagrammatic indicia conveying information about the specificintraoral component, including, for example, the name or otheridentifier of a specific subject for whom the intraoral component isintended.

In some embodiments, the intraoral component comprises a tracker thattracks the amount of time the intraoral component has been used and/ortracks the number of times one or more sensors has been activated. Insome such embodiments, once a maximum recommended use level has beenachieved, an alarm or warning is provided indicating that the intraoralcomponent use should be discontinued and a new intraoral component usedin its place.

While exemplary intraoral components have been described above, itshould be understood that various embodiments of the systems and methodsprovided herein may employ different intraoral component designs andconfigurations. For example, the intraoral devices described in U.S.Pat. No. 7,238,145 and U.S. Pat. Publ. No. 2003/0078521, each of whichis herein incorporated by reference in its entirety, may be employed. Insome embodiments, the intraoral component employs an IOPI device (IOPIMedical, Redmond, Wash.) (see e.g., Adams et al., Dysphagia, 2013, Mar.7 Epub), herein incorporated by reference in its entirety). In someembodiments, the intraoral component employs an electrical neuromuscularstimulator (see e.g., U.S. Pat. Nos. 7,039,468 and 7,280,873, hereinincorporated by reference in their entireties).

II) Communication Component

In some embodiments, the systems and methods comprise a communicationcomponent. In some embodiments, the communication component communicatesinformation from the sensors to an information processing component. Insome embodiments, the communication component communicates informationto the sensors (e.g., from the information processing component). Insome embodiments, the communication component communicates informationfrom any one component of the system (e.g., a tracking component on theintraoral component) to any other component of the system or between twosub-components of the system.

In some embodiments, a portion or all of the communication component iswired. For example, in some embodiments, the communication componentcomprises wires connecting the sensors directly or indirectly to aninformation processing component (e.g., computer). In some embodiments,each sensor is attached by one or more wires directly or indirectly toan information processing component. FIG. 1 shows one embodiment of sucha wired connection. In FIG. 1, each sensor is connected at each sensorlocation to a metal wire. The wire travels from the sensor either alongthe linear branch or the central linear portion of the frame of theintraoral component. The wires run together in parallel to the proximalend of the central linear portion of the frame of the intraoralcomponent. In this embodiment, the wires are contained within a channelin a rubber coating of the intraoral component. In some embodiments, thewires travel from the proximal end of the intraoral device to a signalprocessing component that converts analog information from the sensorinto digital information. In some embodiments, the wires terminate at anadaptor at the proximal end of the intraoral device. In suchembodiments, a cable may be employed to transfer the signal from thewires to a signal processing component by plugging the cable into theadapter. In some embodiments, the signal processing component isattached to the information processing component via a cable.

In some embodiments, a portion of or the entire communication componentis wireless. Any desired wireless communication technology may beemployed, including but not limited to, electromagnetic wirelesstelecommunications (e.g., two-way radio, wireless networking, cellular,satellite), light (e.g., visible, infrared (IR), etc.), sonic (e.g.,ultrasonic), electromagnetic induction, etc. Where wireless sensornetworks are employed, any desired protocol can be used (e.g., ZigBee,EnOcean, Personal area networks, Bluetooth, TransferJet,Ultra-wideband).

In some embodiments, the intraoral component comprises a wirelesscommunication component such that signal generated from the sensor(s) istransmitted to an information processing component wirelessly. In somesuch embodiments, the intraoral component does not contain communicationwires. In some such embodiments, no signal processing component isneeded or used to convert analog information into digital informationprior to receipt of information by the information processing component.In some embodiments, the communication component communicatesinformation (e.g., time-stamped metrics) comprising sensor data and/or aunique serial number associated with the device via a chip to aninformation processing component.

III) Information Processing Component

In some embodiments, the systems and methods comprise an informationprocessing component. The information processing component can provide avariety of functions, including but not limited to: receiving andprocessing information generated by the sensors; receiving andprocessing information generated by chip with a serial number;displaying information to a subject; displaying information to acaregiver; storing information; storing, transmitting, executing, and/ordisplaying protocols (e.g., diagnostic or therapeutic protocols);tracking use of the intraoral component; and presenting alarms.

In some embodiments, the information processing component comprises oneor more of a computer processor, computer readable medium, and software.Any of a variety of computing devices may be used as the informationprocessing component, including but not limited to, a desktop computer,a mainframe computer, a laptop computer, a personal digital assistant(PDA), a portable computer (e.g., mobile devices such as telephones), atablet computer (e.g., standard tablets, slates, mini tablets, phablets,customer handheld devices), and a wearable computer (e.g., helmet,eyeglass, wristwatch, clothing, etc.).

In some embodiments, the information processing component or a device inelectronic communication with the information processing component(e.g., a video monitor) comprises a display. In some embodiments, thedisplay displays textual and/or graphical information to a user (e.g., asubject using an intraoral component). In some embodiments, the displaydisplays information to the user related to pressure readings inreal-time. In some embodiments, the display is a touchscreen display,permitting the user to select and manage system functions via agraphical interface. In some embodiments, audio information is conveyed(e.g., via speakers, headphones, etc.). In some embodiments, a graphicalimage is presented to the user in the form of a meter with a barindicating the current pressure applied. In some embodiments, the meterincludes color zones that signify goal regions (e.g., one color too low;one color in target region; one color over goal). In some embodiments,the meter further comprises a numerical read-out showing a quantitativeamount of pressure applied (e.g., in hPa units). In some embodiments,the interface further provides textual instructions (e.g., keeppressing; press harder; goal met). In some embodiments, the interfaceprovides an additional graphical interface of goals met (e.g., thumbsup/thumbs down). In some embodiments, the interface shows an image ofthe intraoral device and sensors, indicating which sensor is active orto be targeted. The user interface may also provide step by stepinstructions of setting up, using, and managing the devices and systems.The interface may launch automatically when an intraoral device isplugged into a user's computing device.

In some embodiments, the information processing component or a device inelectronic communication with the information process componentcomprises a networking component. The networking component receivesand/or transmits information to the communication component.

In some embodiments, the computer readable medium comprises a databasecontaining protocols, subject data, historic data, or other desiredinformation.

In some embodiments, the information processing component comprises anartificial intelligence component (e.g., embodied in software running onthe processor). In some embodiments, the artificial intelligencecomponent alters stored protocols in response to data obtained from oneor more subjects.

IV) Protocol Component

In some embodiments, the systems and methods comprise a protocolcomponent. The protocol component comprises instructions, typicallyembodied in software, for managing the diagnostic and therapeutic use ofthe systems and methods. In some embodiments, the protocol component isstored in a computer readable medium. In some embodiments, the protocolcomponent is embodied in the information processing component.

In some embodiments, the protocol component directs the display ofinformation. In some embodiments, the display comprises instructions(e.g., graphical, textual, audio, etc.) for use of the intraoralcomponent. For example, in some embodiments, a graphical image of theintraoral device is provided on the display showing the location andtiming of sensors to be actuated by the user. In some embodiments, agraphical cue, such as a color change or motion is used to indicatewhich sensor to actuate. In some embodiments, quantitative informationis conveyed. For example, the amount of pressure applied to a sensor isshown either numerically or graphically (e.g., degree of color change,size of graphical indicator, etc.). In some embodiments, informationconveyed comprises knowledge of performance completing a task (e.g.,“goal met or not met”). In some embodiments, the format of the displayis adjustable to accommodate any subject type, including those withimpaired vision or hearing, impaired cognitive skills, color blindness,young age, varied language skills or knowledge, etc.

In some embodiments, the protocol component comprises data storage andmanagement capabilities. Data storage includes data storage andmanagement for individual subjects, for example, to monitor swallowingcapability over time. In some embodiments, data storage also includesstorage and management for multiple subjects, for example, to makecomparative analysis and/or improve artificial intelligence capabilitiesof the system.

In some embodiments, the protocol component comprises diagnosticprotocols. In some embodiments, diagnostic protocols assess a subject'sswallowing, breathing, speech, or other physical capability, forexample, by assessing the amount of pressure a subject applies to one ormore sensors of the intraoral component. For example, in one embodiment,the protocol instructs a processor to display a graphical image of thesensors of an intraoral component on a computer tablet. An individualsensor is highlighted on the display. The subject actuates thecorresponding sensor with their tongue. If the subject depresses theincorrect sensor, a notice is provided on the display until the correctsensor is actuated. Once the correct sensor is actuated, the sensorreports the amount of pressure applied to the information processingcomponent. The data is recorded. In some embodiments, the protocolinstructs the processor to report the result to the subject or ahealthcare provider, secure server, or other device. The process isrepeated one or more times with one or more sensors. In someembodiments, the collected data represents the swallowing capability ofthe subject. In some embodiments, the collected data represents thebreathing capability of the subject. The data may be compared toprevious measurements to determine whether the subject has improved,maintained, or decreased capability. In some embodiments, the diagnosticprotocol is used to assess the impact of a medical intervention (e.g.,drug, surgery, diet change, etc.), adverse medical event (e.g., nervedamage, allergy, food interaction, poisoning, stroke, infection, cancer,etc.), or other event or process (e.g., aging) on swallowing capability.

In some embodiments, a diagnostic protocol comprising the steps of: 1)custom-molded mouthpiece is fitted to the patient; 2) maximum lingualisometric and/or pressures during swallowing are measured at 1 or moresensors. Repeat maximum values are collected to assure the maximum isrepresentative of how the patient can typically perform. Once threevalues are collected that vary by less than 5%, the maximum value ofthose three presses is called the One repetition Maximum (1RM). If nothree values vary by less than 5%, then the median value of nine maximumpress attempts is considered the 1RM; 3) 1RM results are compared withage/gender normative data; 4) Therapeutic and/or further diagnosticrecommendations are made based on results; 5) Repeat steps 2 and 3 toassess change over time.

In some embodiments, the protocol component comprises therapeuticprotocols. In some embodiments, therapeutic protocols instruct a subjectto use the intraoral device over a period of time to improve swallowingcapability (e.g., increase swallowing capability, maintain swallowingcapability, reduce the rate of loss of swallowing capability, etc.). Insome such embodiments, an exercise regime is displayed to the subject.The exercise regime instructs the subject to actuate one or more of thepressure sensors with their tongue in a particular order, time, and/oramount of pressure. The specific protocol selected for the subject maybe based on an initial screening or diagnostic test. Over time,alternative protocols are selected to continuously challenge the subjectbased on their current level of capability. Alternative intraoralcomponents may be selected based on the level of skill of the subject.In some embodiments, data collected during the therapeutic protocol isused by a healthcare provider to optimize patient care and/or todiagnose medical conditions. For example, in some embodiments, thesubject's performance over time (e.g., days, weeks, months, years), ismonitored and aberrant results are flagged for further analysis. Forexample, if a subject is making steady improvement in swallowingstrength, but then regresses, the cause of the regress is investigatedor, based on the nature of the regress, perhaps diagnosed directly fromthe data.

The protocols employed can be selected and optimized for any desiredimproved function. In some embodiments, improved swallowing coordination(e.g., timing) is desired. In some embodiments, improved strength (e.g.,pressure) is desired. In some embodiments, improved tongue baseretraction is desired. In some embodiments, one or more of theseimproved functions, or other function, are desired. Improvement of suchfunctions provides improved swallowing function, including but notlimited to shorter bolus transit times and better bolus clearance.

In some embodiments, an exemplary 8-week course of treatment comprises:

Session 1—week 1 fit custom-molded mouthpiece; determine baselinemaximum tongue pressures on 1 or more sensors and identify therapeuticgoals. Therapy target is set at 60% of maximum. Patient completes 10lingual press repetitions on each targeted sensor, 3 times per day on 3days per week

Session 2—week 2 increase therapeutic goals to 80% of baseline maximum.Patient completes 10 lingual press repetitions on each targeted sensorwith new goals, 3 times per day on 3 days per week.

Session 3—week 3 remeasure maximum lingual pressures at 1 or moresensors and adjust therapy goals to 80% of new maximum values. Patientcompletes 10 lingual press repetitions on each targeted sensor with newgoals, 3 times per day on 3 days per week.

Session 4—week 5 remeasure maximum pressures at 1 or more sensors adjusttherapy goals to 80% of new maximum values. Patient completes 10 lingualpress repetitions on each targeted sensor with new goals, 3 times perday on 3 days per week.

Session 5—week 7 remeasure maximum pressures at 1 or more sensors adjusttherapy goals to 80% of new maximum values. Patient completes 10 lingualpress repetitions on each targeted sensor with new goals, 3 times perday on 3 days per week. Session 6—week 8 remeasure maximum pressures at1 or more sensors. Initiate maintenance program. Maintenance is 10lingual press repetitions on each targeted sensor with goals from thefinal week of intensive therapy, 3 times per day on one day per week.

Protocol may be adjusted in duration and intensity and frequencyaccording to patient's performance.

In some embodiments, the protocol component comprises alarms to maximizethe likelihood that the system is used optimally. For example, in someembodiments, the protocol component comprises system diagnostics and anyidentified anomaly is noted with an alarm. Alarms include audio, text,graphical or other desired warnings sent to the subject, a medicalcaregiver, and/or system manufacturer/distributor. In some embodiments,alarms are used to ensure proper compliance with diagnostic ortherapeutic protocols. For example, if the subject is not properlyfollowing the protocol, the display may indicate such and recommend thecorrect next step. Likewise, if the subject is using the system awayfrom a healthcare provider (e.g., at home), and fails to follow aprotocol (e.g., fails to keep up with a therapeutic protocol), ahealthcare provider is provided with an alarm so that the subject can becontacted (e.g., by phone, text, e-mail, home visit, etc.) to ensurethat the subject stays compliant with the protocol or to identifywhether the patient is suffering from a medical condition or othercircumstance that requires alteration of the protocol or urgentattention. In some embodiments, subjects are notified when softwareupdates are available or then it is time for a therapy session.

In some embodiments, the protocol component comprises a calibrationprocedure. In some embodiments, the calibration procedure runs prior toconducting a therapeutic protocol to establish or confirm deviceoperating parameters, establish “zero” levels, or otherwise prepare thedevice or subject for the therapeutic protocol(s).

In some embodiments, the protocol component has separate menus andfeatures for different users of the system, such as subject andcaregivers. For example, caregivers may be provided access to variousaspects of a subject's therapy, including but not limited to: patientaccount creations, device commissioning, patient therapy routinerecords, graphs of therapy history, alerts for patients who are missingtherapy or are digressing, protocol creation and publishing wizard,swallow administrative features, clinician authentication and credentialmanagement, historical record archiving, patient/patient family accessto CMMS, patient/clinician messaging, FAQs for usage help, and helpnotification system.

The protocol component is built on any desired hardware/softwareplatform. For example, in some embodiments, the system employsMicrosoft's Azure environment to host the CMMS with Microsoft's .Nettechnology stack. C# is used as the development language, SQL Server fordata storage and IIS as a web server.

In some embodiments, everything other than the caregiver's features andfunctions are contained in an at-home system. In such embodiments, thesubject has the intraoral component, the communication component, thesignal processing component, and the protocol component at their homeand the caregiver accesses the needed features, functions, and alarmsvia an online interface. In some embodiments, a portion of the signalprocessing component and/or protocol component is maintained offsite.For example, in some embodiments, data is stored, sent, and received viaa CMMS portal to the offsite location. This allows caregivers to viewpatient progress or respond to patient therapy issues from the CMMS.This also allows the system to function offline and resynchronize laterwhen a connection is available. This also allows the system to send andreceive updates on a regular basis, with a single update on the offsiteserver being able to service many systems at diverse locations.

In some embodiments, software components are provided via an applicationservice provider (ASP) (e.g., are accessed by users within a web-basedplatform via a web browser across the Internet; is bundled into anetwork-type appliance and run within an institution or an intranet; oris provided as a software package and used as a stand-alone system on asingle computer).

V) Chronic Disease Management Systems and Methods

In some embodiments, the systems and methods comprise chronic diseasemanagement (CDM) systems and methods. In some embodiments, the CDMsystem is an organization of patients, clinicians, and third-partiesthat exchange information with each other to effectuate management ofchronic diseases.

In some embodiments, the CDM system comprises a patient device (e.g.,any of the devices or systems described above) in contact and/orcommunication with a patient, a secure server, and a clinician device incontact and/or communication with a clinician. In some embodiments, thepatient device generates a time-stamped metric based on the interactionbetween the patient and the patient device and relays that time-stampedmetric to the secure server. In some embodiments, a secure serverexecutes a protocol on a time-stamped metric to generate alerts (e.g.,messages indicating that a certain metric level criteria has or has notbeen met) and/or reports (e.g., tables of metric values with or withouttime stamps) and relays those alerts and/or reports to a cliniciandevice. In some embodiments, a clinician evaluates alerts and/orreports, makes a treatment decision, and communicates part or all of thetreatment decision with a clinician device. In some embodiments, aclinician device relays messages and/or adjustments to a treatment planto a secure server. In some embodiments, a secure server relays messagesand/or adjustments to a patient device.

In some embodiments, the CDM system is used with the intraoralcomponent, described herein, serving as part or all of the patientdevice and relaying information regarding lingual strength and exerciserecords in order to treat diseases such as dysphagia and sleep apnea. Insome embodiments, the patient device measures blood pressure fortreatment of hypertension, blood sugar for treatment of diabetes, peakexpiratory flow for treatment of asthma or chronic obstructive pulmonarydisorder, or weight for treatment of congestive heart failure.

In some embodiments, the CDM system allows a clinician to maintainpersistent control over the treatment of a patient regardless of thepatient's physical location. In some embodiments, a clinician remains incontact with a patient through the CDM system even as the patient movesamong various settings (e.g., general hospitals, specialty carehospitals, nursing homes, long-term care facilities, ambulatory carecenters, surgical centers, outpatient clinics, physicians' offices,rehabilitation centers, hospice centers, and the patient's home).

In some embodiments, provided herein are systems and methods for chronicdisease management comprising of one or more or all of: a healthmonitoring device in contact and/or communication with a subject with aprotocol; a secure server; and a clinician device in contact with aclinician. In some embodiments, the health monitoring device isconfigured to send time-stamped metrics and receive, collect, manage,and/or store messages from the secure server, the secure server isconfigured to receive, collect, manage, and/or store time-stampedmetrics from the health monitoring device and messages from theclinician device, the secure server is configured to send messages tothe health monitoring device and alerts and/or reports to the cliniciandevice, and the clinician device is configured to send messages to andreceive, collect, manage, and/or store alerts and/or reports from thesecure server. In some embodiments, the health monitoring device is theintraoral component described herein.

In some embodiments, the chronic disease management systems and methodscomprise a health monitoring device that receives information regardinglingual strength and frequency of lingual exercises from a patient. Insome embodiments, this information is used to treat or manage swallowingdisorders, sleep apnea, speech pathologies, etc.

In some embodiments, the methods for chronic disease management compriseone or more or all of the following: a subject performs an exercise,metrics about the exercise are reported to a health monitoring device; asubject performs an exercise using a health monitoring device; thehealth monitoring device sends a report comprising exercise metrics to asecure server; the secure server receives, collects, manages, and/orstores metrics regarding the exercise from the health monitoring device;the secure server sends alerts and/or reports based on the metrics to aclinician device; the clinician device receives, collects, manages,and/or stores alerts and/or reports from the secure server regarding theexercise; the clinician device sends messages informed by the alertsand/or reports to the health monitoring device directly or indirectlyvia the secure server; and a protocol of the health monitoring device ismodified by the messages from the clinician. In some embodiments, themetrics are time-stamped.

In some embodiments, the systems and methods for chronic diseasemanagement are used to treat a swallowing disorder. In some embodiments,a subject with a swallowing disorder performs lingual exercises with anintraoral device. In some embodiments, the intraoral device relaysmetrics regarding the exercise to a clinician device directly orindirectly using one or more third parties. In some embodiments, aclinician receives the exercise metrics and devises treatment plan(e.g., the subject should perform more exercises, the subject shouldincrease the intensity of the exercises, the subject should have theintraoral device refitted, the subject should obtain a new intraoraldevice, the subject should proceed without modification of the treatmentplan, etc.). In some embodiments, the clinician uses the cliniciandevice to send the treatment plan or other messages to the subject'sintraoral device directly or via one or more third parties. In someembodiments, the intraoral device prompts the subject to perform thetreatment plan sent by the clinician. In some embodiments, this CDMmethod is performed continuously independent of the patient's location.

In some embodiments, the clinician is able to access targets, settings,data logs, and any report or archived data. In some embodiments,clinicians have the ability to set certain parameters that users (e.g.,patients) cannot access or easily access. In some such embodiments,control software is provided by a third party service provider andpermissions for users and/or clinicians are set by the third party to asingle user interface used by patients and clinicians (but havingdifferent access based on set permissions). In some embodiments,clinicians are able to override exercise target values by entering newvalues, determine which sensors are active, and determine the durationof the press repetition necessary to be within 10% of the targetpressure. In some embodiments, the clinician is given access to variousaspects of the patient's therapy including: patient account creation;device commissioning; patient therapy routine records; graphs of therapyhistory; alerts for patients who are missing therapy or are digressing;and protocol creation and publishing.

An exemplary information control system is shown in FIG. 5. The patientaccesses a web-based control software system and has access to severalmodules, including Setup New Mouthpiece (e.g., to register and initiatedata collection for a new intraoral device); Patient Therapy (e.g., toselect or manage protocols); Determine Targets (e.g., to set goals); andBase Line Sensors (e.g., to set baseline parameters of intraoral devicesensors). The clinician accesses the web-based control software systemand has access to several modules, including Training (e.g., to displaymouthpiece; to display goal met counters; to display pressure readings;to configure saved and loads for all therapy sessions); Patient Setup(e.g., to initiate an account for a patient); Protocol Setup (e.g., toselect or create a protocol for the patient; setting mandatory restperiods; press duration; target duration; repetition count; percentpressure variation tolerated for goal); and Configure (e.g., toconfigure system parameters such as associating the patient or clinicianinformation with one or more facilities (e.g., hospitals; payers;etc.)).

FIG. 6 shows an exemplary control system as managed between a clinicianand an administrator (e.g., third party service provided; hospitaladministrator, etc.). The clinician accesses a web-based controlsoftware system and has access to several modules, including PatientCreate (e.g., to initiate an account for a patient); Patient Edit (e.g.,to edit patient information); Patient Notifications (e.g., to setnotifications for a particular patient or group of patients); PatientList (e.g., to manage multiple patients); Therapy Protocol (e.g., tocreate or select protocols); Therapy Results (e.g., to record and managedata from therapy); Therapy Training Graphs (e.g., to store and displaydata in graphical form). The administrator accesses the web-basedcontrol software system and has access to several modules, including thePatient Notification, Patient List, Therapy Protocol; Therapy Results;and Therapy Training Graphs of the clinician, as well as admin-onlymodules: Clinician List (e.g., to manage multiple clinicians); ClinicianCreate (e.g., to initiate an account for a clinician); Clinician Edit(e.g., to edit clinician information); Facility List (e.g., to managemultiple facilities, which may be associated with one or moreclinicians); Facility Create (e.g., to initiate an account for afacility); and Facility Edit (e.g., to edit facility information). Insome embodiments, the facility management component allows a singleclinician to be associated with multiple different facilities ormultiple clinicians at different facilities to be associated with asingle patient account. Such embodiments allow fluid management ofpatient care for a subject or clinician that interacts with more thanone caregiver or facility (e.g., as a subject transitions from a shortterm care facility to a long term care facility or home rehabilitationor vice versa).

In some embodiments, kits are provided comprising one or more or all ofthe components necessary, sufficient, or useful to practice any of themethods herein or assemble the systems herein. In some embodiments, akit comprises one or more of: an intraoral device (or multiple thereof;e.g., 5-pack, 10-pack, 25-pack, etc.); a computing device or software(e.g., tablet computer; e.g., GOOGLE NEXUS 10); USB cable; circuit box;carrying case; and software (e.g., on a computer readable medium).

In some embodiments, the kit is packaged in a shipping container. Forshipment and storage, in some embodiments, an intraoral device is placedin a resealable poly pouch and is contained within a small cell airencapsulated poly envelope. Sensor adapters and cords are placed withina poly pouch. The computing device (e.g., tablet) is placed in its ownpaperboard product carton and is wrapped in a graphics display sleeve.Beneath the tablet are paperboard compartments containing a chargingcable and power adapter. A travel bag is placed on the bottom of ashipping containing.

In some embodiments, quality control and/or quality assurance systemsand methods are provide to test and/or confirm the operation of one ormore components of the systems and methods prior to use or in use. Insome embodiments, one or more parameters is assessed. Such tests orparameters include, but are not limited to: clinician ability to specifywhich sensors are active for each user (e.g., for a multi-sensorintraoral device); measurement of pressures generated by the userpreceded by a baseline measure to identify zero; multiple maximumpressures are collected to determine variability and the one repetitionmaximum (1RM) (pressure data can be collected at 100 Hz for maximummeasurement); user feedback received after each repetition indicatingwhether a goal was met (e.g., defined as holding pressure against thesensor +/−10% of the pressure target, for a specific number of secondswithin a four second window); data storage conducted and includes thenumber of repetitions completed and number of repetitions completedsuccessfully meeting a goal; data stored is date and time stamped; datais in a format or formatted such that it is readable in a desiredsoftware system (e.g., MICROSOFT OFFICE SUITE); and data on targetpressures, repetition completions, and success of repetitions is madeavailable in text form.

All publications and patents mentioned in the above specification areherein incorporated by reference as if expressly set forth herein.Various modifications and variations of the described method and systemof the invention will be apparent to those skilled in the art withoutdeparting from the scope and spirit of the invention. Although theinvention has been described in connection with specific preferredembodiments, it should be understood that the invention as claimedshould not be unduly limited to such specific embodiments. Indeed,various modifications of the described modes for carrying out theinvention that are obvious to those skilled in relevant fields areintended to be within the scope of the following claims.

We claim:
 1. A system for assessing swallowing function, comprising: a)an intraoral device comprising an adjustably bendable metal frameconfigured to be placed in a subject's mouth, said device, when placedin the subject's mouth having a central linear portion comprising aproximal end positioned towards an anterior opening of a mouth and adistal end positioned towards a back of the mouth; a first pressuresensor positioned on a first region of said frame; and a second pressuresensor positioned on a second region of said central linear portion ofsaid frame near said distal end of said central linear portion, whereinsaid second region of said central linear portion of said framepositions said second pressure sensor at a boundary between a subject'shard and soft palate when said intraoral device is placed into asubject's mouth; and b) a computing device comprising a display andcomprising a processor in electronic communication with said pressuresensors wherein said processor displays a diagnostic and therapeuticprotocol to said subject that instructs said subject to actuate saidpressure sensors with the subject's tongue over a period of time toimprove lingual strength, wherein said protocol comprises: i)determining baseline maximum tongue pressure on said first or secondpressure sensor; ii) selecting a therapeutic goal; iii) during a firsttime period, directing a plurality of tongue press repetitions of saidfirst and second sensors at a pressure that is a percentage of saidbaseline maximum tongue pressure; iv) during a later second time period,directing a plurality of tongue press repetitions of said first andsecond sensors at a pressure that is an increased percentage of saidbaseline maximum tongue pressure; v) during a later third time period,re-measuring maximum lingual pressures at said first and second sensorsand selecting a new therapeutic goal that is a percentage based there-measured maximum lingual pressures; and vi) directing a plurality oftongue press repetitions of said first and second sensors based on saidnew therapeutic goal; and vii) repeating steps v) and vi) one or moretimes.
 2. The system of claim 1, wherein said frame is stainless steel.3. The system of claim 1, wherein said pressure sensors are located onan upper or lower surface of said frame.
 4. The system of claim 1,wherein said pressure sensors comprise solid state pressure sensors. 5.The system claim 1, wherein said pressure sensors are polymer thick film(PTF) sensors that exhibit a decrease in resistance with increase inforce applied to the surface of the sensor.
 6. The system claim 1,wherein the computing device comprises a computer chip with a uniqueserial number.
 7. The system of claim 1, wherein said frame has acomposition and shape that provides tensile strength, malleability, andductability sufficient to withstand stress associated with bending up to90 degrees.
 8. The system of claim 1, wherein said device furthercomprises a communication component that transmits information from saidpressure sensors to said computing device.
 9. The system of claim 8,wherein said communication component is a wireless communicationcomponent.
 10. The system of claim 1, wherein said computing devicecomprises a tablet computer.
 11. The system of claim 1, wherein saiddiagnostic and therapeutic protocol involves said computing deviceassessing sensor press direction, rest periods between sensor presses,target duration, and repetition count.
 12. A method of assessingswallowing function, comprising: a) placing the intraoral device of thesystem of claim 1 within a mouth of a subject; b) bending said frame toposition said sensors against a roof of said mouth; c) running saidprotocol comprising: i) determining baseline maximum tongue pressure onsaid first or second pressure sensor; ii) selecting a therapeutic goal;iii) during a first time period, directing a plurality of tongue pressrepetitions of said first and second sensors at a pressure that is apercentage of said baseline maximum tongue pressure; iv) during a latersecond time period, directing a plurality of tongue press repetitions ofsaid first and second sensors at a pressure that is an increasedpercentage of said baseline maximum tongue pressure; v) during a laterthird time period, re-measuring maximum lingual pressures at said firstand second sensors and selecting a new therapeutic goal that is apercentage based the re-measured maximum lingual pressures; and vi)directing a plurality of tongue press repetitions of said first andsecond sensors based on said new therapeutic goal; and vii) repeatingsteps v) and vi) one or more times.
 13. The method of claim 12, whereinthe subject performs the therapeutic protocol with said device, thedevice generates and sends metrics relating to the therapeutic protocolto a secure server, the secure server generates and sends alerts and/orreports relating to the therapeutic protocol to a clinician device, theclinician device sends messages informed by the alerts and/or reports tothe device directly or indirectly via the secure server, and a protocolof the device is modified by the messages from the clinician device. 14.The method of claim 13, wherein said assessing and therapeutic regimecomprises the steps of: a) in a first week, fitting said intraoraldevice to a mouth of a subject and determining baseline maximum tonguepressures on 1 or more sensors and identifying a therapeutic goal;completing 10 lingual press repetitions on each sensor, 3 times per dayon 3 days in said first week at 60% of therapeutic goal; b) in a secondweek, completing 10 lingual press repetitions on each targeted sensorwith an increased baseline maximum 3 times per day on 3 days per saidsecond week; c) in a third week, re-measure maximum lingual pressures at1 or more sensors and adjust therapy goals to 80% of new maximum values;completing 10 lingual press repetitions on each targeted sensor with thenew goals, 3 times per day on 3 days per said third week; and d) repeatstep c one or more times.